"There Are Always Options at Penn" - Ken Shaw, Head and Neck Cancer Survivor

Ken Shaw could no longer ignore the swollen gland on the side of his neck. At first, he just brushed it off as part of a cold or sore throat, but as weeks went by and it wasn't getting better, he decided to have it checked out by his family physician in Woodbury, NJ.

But he still wasn't worried. After all, Ken never smoked. He was 63, retired, and feeling good. However, when the biopsy came back positive for head and neck cancer, his doctor immediately sent him to head and neck surgeon Gregory Weinstein, MD, at Penn Medicine.

“I had stage 4 cancer, and needed a complicated surgery that involved a graft from my thigh in order to rebuild the back of my throat, but Dr. Weinstein removed the cancer that January, and I started radiation and chemotherapy after that,” remembers Ken. “I really had no time to react to the fact I had cancer because it all moved so fast.”

Ken’s team of cancer specialists at the Abramson Cancer Center had planned with him a road to recovery involving therapy and recovery. The journey was going as planned, but that September of 2009, a PET scan showed a spot on his left lung.

The cancer had spread.

Next Steps

This time, Ken met with a thoracic surgeon at Penn, John Kucharczuk, MD, who would remove the tumor from his left lung as well as third of the lung’s tissue. Ken began chemotherapy and was on the road to recovery again, until another tumor was found on his right lung and Dr. Kucharczuk removed that as well.

“Everyone at Penn worked together,” says Ken. “I had a team of 10 specialists all focused on me, all talking together, and maintaining communication with my primary care doctor in New Jersey. I didn’t need to think about anything but getting well.”

Getting well wasn’t easy for Ken, who fought through one more tumor surgery on his back. But he fought and regained some of the strength he once had.

Getting Back On Course

Ken even got back on the golf course, a game he loved and missed, and did some traveling with his wife.

“I used to belong to a local golf club, and I’d travel with my buddies to go play golf at different courses,” he says. “It felt great to be back on the course.”

Today, Ken is cancer-free, but is facing another diagnosis – multiple sclerosis – for which he is being treated at Penn Medicine.

Ken’s been through a lot, but he’s not giving up.

“I figure, you have to fight it, there isn’t anything else to do...I’m not going to sit back and just fade away,” he says. “You don’t have to give up. There are always options at Penn Medicine.”

Penn Medicine's Abramson Cancer Center is leading the way in breakthrough cancer treatment. If you or someone you know has been touched by cancer, the power to find the Cure is Within. Hear our stories and find out more today.

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5 Things to Know about Head and Neck Cancer Treatment

Head and neck cancer is cancer that originates in the head and neck areas with a few exceptions, such as cancer that originates in the brain.

Head and neck cancers can originate in the following sites:

• Nasopharynx
• Cancer of the oral cavity including lips, gums, inside of cheeks, part of the tongue, floor of the mouth under the tongue, palate and area behind wisdom teeth
• Salivary glands
• Paranasal sinuses and nasal cavity
• Oropharynx (Base of tongue, tonsils)
• Larynx, or voicebox
• Hypophyarnx
• Lymph nodes of the neck

Because head and neck cancer is often located in difficult to reach areas, it’s important to ask a lot of questions from your head and neck cancer treatment team.

About Head and Neck Cancer

There are approximately 42,000 new cases of head and neck cancer in the United States every year. And, while the biggest risk factor for head and neck cancer is smoking and tobacco use, the fastest growing population of people affected by head and neck cancer is young, otherwise healthy adults. This is due to the rise in cases of HPV.

Here are 5 things to know, or ask your cancer center before having head and neck cancer treatment.

What type of surgery is offered for head and neck cancer?

Penn physicians Drs. Gregory Weinstein and Bert O’Malley invented and developed the TransOral Robotic Surgery procedure, or TORS.

TORS, for the first time, has allowed surgeons to gain greater access to the areas of the throat for the removal of cancers and benign lesions via a minimally invasive robotic approach. The surgeon benefits by having improved access to the tight confines of the throat and the patient benefits in the short-term by faster and easier recovery and, in the long-term, by outstanding cancer results and improved swallowing results compared to alternative treatments.

Benefits of TORS can include:

• Quicker return to normal activity
• Shorter hospitalization
• Reduced risk of long-term swallowing problems that are more commonly seen when chemoradiation or traditional open surgery is used for definitive treatment instead of robotic surgery
• Fewer complications compared to traditional open surgery
• Less scarring than traditional open surgery
• Less risk of infection
• Less risk of blood transfusion when compared to open surgery
• No routine use of tracheostomy during surgery compared to routine use for open surgery

The medical literature confirms that TransOral Robotic Surgery's revolutionary technique contributes to improved outcomes for cancers and benign lesions of the mouth, voice box, tonsil, tongue and other parts of the throat.

"Thank you for saving my life."- A patient from Penn writes about her experience with TORS and Penn Medicine. Read her story here.

How will my radiation oncologist, surgeon and medical oncologist all know what each other is doing?

One of the benefits of getting your cancer care at the Abramson Cancer Center is getting multi-disciplinary care in a comprehensive cancer center.

To you, the patient, this means seamless care from a center designated as “exceptional” from the National Cancer Institute. It means never having to worry one physician won’t know what the other is doing. It also means getting access to all specialists under one roof.

To us, it means collaboration. It means that we know and trust each discipline to offer you the best, world-class cancer care.

Does your cancer center offer proton therapy?

Proton therapy for head and neck cancer offers more cancer-focused radiation extreme precision. This means that radiation can be delivered to difficult-to-reach areas of the head and neck with less exposure of surrounding tissues and organs, translating to potentially significant reductions in patient-experienced side effects

The Roberts Proton Therapy Center at Penn Medicine is the largest and most advanced proton therapy facility in the world. It’s also the only proton therapy center housed within an academic medical institution.

Will I be able to get pencil-beam proton therapy for head and neck cancer?

Pencil beam proton therapy allows for precise radiation delivery to the areas at risk for cancer involvement, while minimizing dose to normal tissues. We currently offer pencil beam proton therapy primarily to patients with cancers of the oropharynx, whether after surgery, or for patients who cannot receive surgery, in place of surgery. Only a few proton centers in the United States offer pencil beam proton therapy, and Penn Medicine is one of them.

What support services will I have access to?

As a comprehensive cancer center, the Abramson Cancer Center is proud to offer patients access to many support services.

From patient navigators who can walk patients through each step of care, to social workers who can help patients get outside support, the Abramson Cancer Center wants to ensure all patients get world-class care.

The Abramson Cancer Center also offers patients:

• Nutrition services
• Integrative medicine and wellness services including yoga, acupuncture and reiki
• Support groups
• The LIVESTRONG Survivorship program
• Access to clinical trials for cancer

Learn More About Head and Neck Cancer Treatment At Penn

To learn more about head and neck cancer, and to learn if you are a candidate for TORS or proton therapy for head and neck cancer, please make an appointment with a Penn specialist by calling 1-800-789-PENN (7366).

Learn more about head and neck cancer treatment at Penn Medicine from the Focus on Head and Neck Cancers Conference.

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Minimally Invasive Surgery for Head and Neck Cancer with TORS

Penn Medicine's TransOral Robotic Surgery (TORS) program is a world-class surgical program comprised of the leading surgeons, anesthesiologists, nurses, and operating personnel dedicated to providing superior patient outcomes through the use of robotic-assisted technology. The program benefits not only patients seeking state-of-the-art care, but also physicians who come from around the world to observe and learn about this groundbreaking procedure.

TransOral Robotic Surgery may either allow the patient to avoid radiation altogether or decreases the intensity thereby avoiding side effects of treatment.

TORS is the world's first group of minimally invasive robotic surgery techniques enabling surgeons to remove benign and malignant tumors of the mouth and throat. This revolutionary breakthrough results in shorter, virtually scarless head and neck surgery. Designed to avoid incisions for primary site resection, TORS is performed through the patient's mouth and provides unprecedented access to the small and often difficult-to-reach areas of the mouth and throat.

Transoral robotic surgery (TORS) was invented and developed by the pioneering team of Bert W. O'Malley, Jr., MD and Gregory S. Weinstein, MD at Penn Medicine

TORS uses the state-of-the-art da Vinci® Surgical System, which allows surgeons better access to the areas of the throat for the removal of cancers and benign lesions via a minimally invasive robotic approach.

Surgeons benefit by having improved access to the tight confines of the throat and patients benefit in the short term with a faster and easier recovery and, in the long term, by outstanding cancer results and improved swallowing results compared to alternative treatments.

Benefits of TORS can include:

• Quicker return to normal activity
• Shorter hospitalization
• Reduced risk of long-term swallowing problems (most commonly seen with chemoradiation or traditional open surgery)
• Fewer complications compared to traditional open surgery
• Less scarring than traditional open surgery
• Less risk of infection
• Less risk of blood transfusion when compared to open surgery

In this video, Drs. O'Malley and Weinstein explain the TORS procedure, and how Penn Medicine is revolutionizing care for patients with head and neck cancer.

TORS patient, Cynthia Miller along with other Penn patients discuss how the TORS procedure changed their lives.

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Preventing Head and Neck Cancer with the HPV Vaccine

There are over 100 types of HPV, and more than 40 strains that can infect the genital areas of men and women, as well as the mouth and throat. HPV is passed through genital contact through vaginal and anal sex, and can also be passed through oral sex.

HPV and Head and Neck Cancer

The connection you should know about

In recent years, the human papilloma virus (HPV) has been linked to cervical, anus and skin cancers.

“HPV is the most common sexually transmitted infection in the United States,” says Ann Honebrink, MD, associate professor of clinical obstetrics and gynecology at Penn. “Even without showing symptoms of HPV, people can transmit the virus and barrier methods like condoms don’t work as well to prevent HPV transmission as they do other infections like HIV.”

While HPV can cause symptoms, a person can go for years without ever knowing they have the virus. That, along with the ability of the HPV virus to remain present in a person for a long time, make this virus so prevalent — people continue to spread the virus through sexual contact without knowing they carry the virus. In most cases, the body fights off HPV naturally and eventually the virus is cleared. However, when the body cannot fight off HPV, the virus can persist and also can trigger cellular changes that may lead to cancer.

“Some types of HPV must be present in order for a women to develop squamous cell cancer of the cervix, the most common type of cervical cancer,” says Dr. Honebrink.

Oral cancer – HPV’s new connection

While HPV has most been linked to cervical, anus and skin cancers, recent studies suggest the same strain of HPV can also cause oropharyngeal (head and neck) cancer.

“We are seeing more cancer located at the base of the tongue and in the tonsils,” says Jason Newman, MD, assistant professor of otorhinolaryngology, and head and neck surgeon at Pennsylvania Hospital.

Oropharyngeal cancer develops in the part of the throat including the back of the tongue, back part of the roof of the mouth, the tonsils, and the side and back wall of the throat.

“Historically, people who get head and neck cancer are older – over 70 – and have been heavy smokers or drinkers,” says Dr. Newman. “But we are seeing an increase in young, otherwise healthy men and women who develop head and neck cancer related to the HPV virus.”

Treatment for head and neck cancer may include trans-oral robotic surgery (TORS). TORS is the world’s first group of minimally invasive robotic surgery techniques enabling surgeons to remove tumors of the mouth and throat. This revolutionary breakthrough results in shorter, virtually scarless head and neck surgery. TORS is performed through the patient’s mouth and provides unprecedented access to the small and often difficult-to-reach areas of the mouth and throat.

Surgeons at Penn Medicine created da Vinci TransOral Robotic Surgery (TORS) in 2005. The adoption of this highly advanced robotics technique demonstrates Penn Medicine’s commitment to providing world-class health care.

“It’s important to know the signs of head and neck cancer, and to not ignore symptoms that do not go away,” says Dr. Newman. “Treatment options and outcomes improve greatly when cancer is found early.”

Preventing HPV

The good news is that there is protection for both girls and boys who have not yet encountered the HPV virus. There are two FDA approved HPV vaccines on the market: Gardasil and Cervarix.

Gardasil protects against four major types of HPV; HPV 16 and 18, the two types that cause about 70 percent of cervical cancer and HPV 6 and 11,which cause 90 percent of genital warts.

Cervarix protects against HPV 16 and 18.

HPV vaccines are given as three shots to protect against HPV infection and HPV-related diseases, and they offer the greatest health benefits to individuals who receive all three doses before having any type of sexual activity. This is why the HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years.

Facts about HPV

• Nearly 20 million people in the United States are infected with HPV.
• 6.2 million Americans become infected each year with more than 50 percent of sexually active men and women infected with HPV at some time in their lives.
• Most HPV infections do not cause any symptoms and go away on their own.
• HPV can cause genital warts and warts in the oral and upper respiratory tract in both men and women.

There is no treatment for an HPV infection, but many of the conditions it causes can be treated.

Learn more about the latest HPV vaccine recommendations, and treatment for head and neck cancer at Penn.

Read More

Chemotherapy and Radiation Therapy for Head and Neck Cancer: Keep Your Mouth Healthy

Elizabeta Evtimovska, DDS, MS, is a maxillofacial prosthodontist at Penn Medicine. In this article, she discusses chemotherapy and radiation therapy for head and neck cancer, their complications, and how patients can prevent long-term side effects of head and neck cancer treatment.

Chemotherapy and radiation therapy for head and neck cancer can cause a range of short and long-term oral complications.

The acute complications such as mucositis (sores) and infections, as well as others are managed by the oncology team during the treatment. Some of the long-term complication, such as xerostomia (dry mouth) and osteoradionecrosis (ORN), is a serious complication of radiation therapy for head and neck cancer that occurs in a small percentage of patients as result of head and neck radiation treatment.

Osteoradionecrosis is bone that has died. Because radiation works to destroy cancerous cells through the deprivation of oxygen and vital nutrients, it inevitably destroys normal cells as well, damaging small arteries and reducing circulation to the area of the mandible (jaw bone).

As there is no treatment for ORN, the focus is on prevention. This means, avoiding extractions of teeth from the radiated parts of the jaws and making sure that dentures fit properly and don’t cause any sores. It most often occurs in the setting of tooth extraction from the radiated parts of the jaws, but can also occur spontaneously. In both cases, there is exposed bone in the mouth which can be asymptomatic or it can be further complicated by infections, pain, and/or malodor.

Preparing for Chemotherapy and Radiation Therapy for Head and Neck Cancer

Patients who are planning to undergo chemotherapy or radiation therapy for head and neck cancer should be evaluated by a dentist prior to the start of treatment.

During this appointment, the patient’s oral condition is evaluated and it is determined if any teeth need to be extracted prior to the start of radiation therapy. This visit is also a perfect time to go over good oral health care.

In our practice, I advise patients to do the following during and after radiation:

• Maintain excellent oral hygiene by flossing and brushing every morning and evening and after every meal. If dry mouth develops, it is especially crucial to brush teeth after every meal and only drink water between meals, as opposed to sugary drinks or snacks.
• Use fluoride to prevent caries (when xerostomia, dry mouth, is present, the patient has increased risk of caries). Fluoride is especially important to prevent extracting teeth from the radiated parts of the jaws and therefore prevent osteoradionecrosis.
• Visit a local dentist regularly for regularly scheduled maintenance visits (cleanings), as well as any other routine dental treatment.

The severity of oral complications from chemoradiation differs depending on the diagnosis, the type of treatment administered, the amount and location of the delivered radiation, etc. Therefore, it is best to consult with a dentist prior to and after radiation in terms of the above discussed needs and recommended treatment.

Learn about managing cancer treatment side effects.

Learn about the Abramson Cancer Center Center’s Center for Head and Neck Cancer.

Read More

Free Head and Neck Screening in Philadelphia

The Joan Karnell Cancer Center at Pennsylvania Hospital is offering a free screening for oral, head and neck cancer from 11 am to 3 pm on Friday, April 19, 2013.

Oral, head and neck cancer refers to a variety of cancers that develop in the head and neck region, such as the oral cavity (mouth), the pharynx (throat), paranasal sinuses and nasal cavity, the larynx (voice box), thyroid and salivary glands, the skin of the face and neck, and the lymph nodes in the neck.

Common symptoms of oral, head and neck cancer

• Red or white patch in the mouth that lasts more than two weeks
• Change in voice or hoarseness that lasts more than two weeks
• Sore throat that does not subside
• Pain or swelling in the mouth or neck that does not subside
• Lump in the neck

Later symptoms of oral, head and neck cancer

• Ear pain
• Difficulty speaking or swallowing
• Difficulty breathing

The most effective prevention strategy continues to be the cessation of behaviors such as smoking, use of chewing tobacco and excessive alcohol consumption.  Eighty-five percent of head and neck cancers are related to tobacco use.  

Research has linked the increase of oral cancer incidence in young adults, a population traditionally at low risk, to the rise of human papillomavirus (HPV), a cancer-causing virus that can be transmitted through oral sex.

Date: Friday, April 19 2013
Time: 11 am to 3pm
Location: Pennsylvania Hospital, Otorhinolaryngology – Head and Neck Surgery (adjacent to the Spruce Building) 811 Spruce Street, Philadelphia, PA 19107

To register for this free event, call 800-789-PENN (7366).

For more information, call 215-829-6466

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"Thank You For Saving My Life," From a Tonsil Cancer Survivor

Susan Bolinger

Susan Bolinger of Elverson, PA, had a nagging sore throat that wouldn’t go away. After a tonsillectomy revealed she had tonsil cancer, she had a tonsil dissection, and Trans-Oral Robotic Surgery (TORS), a revolutionary surgery for the head and neck developed by Drs. Bert O’Malley and Gregory Weinstein at Penn Medicine.

In this post, Susan writes about her diagnosis and treatment for tonsil cancer. 

For a year I had a nagging sore throat my regular doctors believed was something else. It wasn’t until I had a tonsillectomy that they discovered I had tonsil cancer, and needed more surgery.

Contrary to my fears (thank you, Google!) the throat dissection went smoothly. The surgeon removed 32 lymph nodes, and 2 of them had cancer.

Even after the surgery, the scar blended in nicely with my neck wrinkles!

Getting Out The Cancer

TORS is the world's first group of minimally-invasive robotic surgery techniques enabling surgeons to remove benign and malignant tumors of the mouth and throat. This revolutionary breakthrough results in shorter, virtually scarless head and neck surgery. Designed to avoid incisions for primary site resection, TORS is performed through the patient's mouth and provides unprecedented access to the small and often difficult-to-reach areas of the mouth and throat.

I was scheduled to have TORS 3 weeks later to remove the tumor. I can’t begin to tell you how thankful I am that we live close to Penn Medicine in Philadelphia, where I had access to first-class care by the surgeons who developed the TORS procedure.

You see, Drs. O’Malley and Weinstein developed and perfected TORS. I mean, can you think of anyone better to perform TORS than the team that actually developed it?

The team at Penn was amazing, and did so much to relieve my fears and stress. I never felt hurried, and even though I baked an apple pie for my TORS team the day of the surgery, I am confident I would have gotten the same fabulous treatment without baked goods!

In all seriousness though, if I didn't have TORS, the surgery would have involved surgically breaking my jaw and multiple incisions to get to where they needed to be to remove the tumor. Instead, the entire procedure was performed through my mouth with no further cuts to the outside of my neck.

No more scars to add to my neck wrinkles!

The only tough part about the surgery was enduring the breathing tube in for a few days following surgery. Also, I had a nostrogastic feeding tube (a tube that went up one of my nostrils) which was thankfully removed in about ten days.

Next Up: Radiation for Tonsil Cancer

My team recommended I have radiation after surgery to kill any nasty remaining cancer cells that could be floating around in my throat area.

Kill cancer cells? I was happy to oblige!

Every day for 6 weeks we headed to Penn to have radiation treatment. Again, the clinical staff and team were fantastic. They entertained my sense of humor, and somehow made the time fly.

Radiation treatment itself was no walk in the park. I had a sore throat, lost my appetite, and was so tired I took up permanent residence on our couch. But if that’s what it took to kill those cancer cells, then that’s what I was going to do.

I finished my radiation treatment on Christmas Eve, 2012. As I rang the bell, I felt relief and joy. Some of that joy was from weight loss, but nonetheless, I was happy to be done with treatment knowing I got the best care available at Penn Medicine.

Susan Today

Today, I am cancer-free. Things are going well, and I feel better and stronger every day.

And, I have Penn Medicine and Drs. O’Malley and Weinstein to thank for that.

Read more about Susan’s cancer fight, and get a dose of her humor on her blog, How the Heck Am I?

Learn more about TORS at Penn

Watch this video about TORS featuring interviews with Drs. O'Malley and Weinstein.

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Awareness Month: Testicular, Esophageal and Head and Neck Cancers

April is testicular, esophageal and head and neck cancer. Be sure to subscribe to the Focus On Cancer blog, and "like" the Abramson Cancer Center Facebook page for information about testicular, esophageal and head and neck cancer throughout the entire month.

At a Glance: Testicular Cancer

• Testicular cancer is most common in young or middle-aged men, and the most common cancer in men ages 15 to 34.
• If detected early, the survival rate is high. In 2013, it is estimated there will be 7,920 new cases of testicular cancer, and there will be 370 deaths from testicular cancer.
• Some risk factors for testicular cancer include: Having an undescended testicle, having a testicle that is smaller, and does not function normally, having had abnormal development of the testicles, being Caucasian, and having a personal or family history of testicular cancer.

Learn more about the treatment for testicular cancer at the Abramson Cancer Center.

At a Glance: Esophageal Cancer

• It’s estimated 17,990 new cases of esophageal cancer will be diagnosed this year, and there will be 15,210 deaths from esophageal cancer.
• Men are three times more likely than women to be diagnosed with esophageal cancer.
• Esophageal cancer has been linked to alcohol and tobacco use, as well as gastroesophageal reflux disease, or GERD.

Learn more about treatment for esophageal cancer at the Abramson Cancer Center.

Join the esophageal cancer monthly support group at the Joan Karnell Cancer Center at Pennsylvania Hospital for patients with esophageal cancer and their caregivers, focusing on surgical side effects, nutrition and social issues.

At a Glance: Head and Neck Cancer

• Most head and neck cancers begin in the lining of the head and neck.
• Head and neck cancer has been linked to tobacco use, alcohol use, and HPV.
• Drs. Bert O’Malley and Greg Weinstein of Penn Medicine developed Trans-Oral Robotic Surgery, a minimally invasive, robotically assisted surgical approach to removing tumors of the mouth, throat and voice box that dramatically improves the treatment of head and neck cancers.

Learn more about treatment for head and neck cancer at the Abramson Cancer Center.

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HPV and Head and Neck Cancer

January is cervical cancer awareness month. The human papillomavirus (HPV) is the most common sexually transmitted virus in the United States, and also a risk factor for cervical cancer. In this blog post, we discuss a new type of cancer associated with HPV- head and neck cancer. 

There are over 100 types of HPV, and more than 40 strains that can infect the genital areas of men and women, as well as the mouth and throat. HPV is passed through genital contact through vaginal and anal sex, and can also be passed through oral sex.

HPV and Head and Neck Cancer

The connection you should know about

In recent years, the human papilloma virus (HPV) has been linked to cervical, anus and skin cancers.

“HPV is the most common sexually transmitted infection in the United States,” says Ann Honebrink, MD, associate professor of clinical obstetrics and gynecology at Penn. “Even without showing symptoms of HPV, people can transmit the virus and barrier methods like condoms don’t work as well to prevent HPV transmission as they do other infections like HIV.”

While HPV can cause symptoms, a person can go for years without ever knowing they have the virus. That, along with the ability of the HPV virus to remain present in a person for a long time, make this virus so prevalent — people continue to spread the virus through sexual contact without knowing they carry the virus. In most cases, the body fights off HPV naturally and eventually the virus is cleared. However, when the body cannot fight off HPV, the virus can persist and also can trigger cellular changes that may lead to cancer.

“Some types of HPV must be present in order for a women to develop squamous cell cancer of the cervix, the most common type of cervical cancer,” says Dr. Honebrink.

Oral cancer – HPV’s new connection
While HPV has most been linked to cervical, anus and skin cancers, recent studies suggest the same strain of HPV can also cause oropharyngeal (head and neck) cancer.

“We are seeing more cancer located at the base of the tongue and in the tonsils,” says Jason Newman, MD, assistant professor of otorhinolaryngology, and head and neck surgeon at Pennsylvania Hospital.

Oropharyngeal cancer develops in the part of the throat including the back of the tongue, back part of the roof of the mouth, the tonsils, and the side and back wall of the throat.

“Historically, people who get head and neck cancer are older – over 70 – and have been heavy smokers or drinkers,” says Dr. Newman. “But we are seeing an increase in young, otherwise healthy men and women who develop head and neck cancer related to the HPV virus.”

Treatment for head and neck cancer may include transoral robotic surgery (TORS). TORS is the world’s first group of minimally invasive robotic surgery techniques enabling surgeons to remove tumors of the mouth and throat. This revolutionary breakthrough results in shorter, virtually scarless head and neck surgery. TORS is performed through the patient’s mouth and provides unprecedented access to the small and often difficult-to-reach areas of the mouth and throat.

Surgeons at Penn Medicine created da Vinci TransOral Robotic Surgery (TORS) in 2005. The adoption of this highly advanced robotics technique demonstrates Penn Medicine’s commitment to providing world-class health care.

“It’s important to know the signs of head and neck cancer, and to not ignore symptoms that do not go away,” says Dr. Newman. “Treatment options and outcomes improve greatly when cancer is found early.”

Preventing HPV

The good news is that there is protection for both girls and boys who have not yet encountered the HPV virus. There are two FDA approved HPV vaccines on the market: Gardasil and Cervarix.

Gardasil protects against four major types of HPV; HPV 16 and 18, the two types that cause about 70 percent of cervical cancer and HPV 6 and 11 which cause 90 percent of genital warts.
Cervarix protects against HPV 16 and 18.

HPV vaccines are given as three shots to protect against HPV infection and HPV-related diseases, and they offer the greatest health benefits to individuals who receive all three doses before having any type of sexual activity. This is why the HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years.

Facts about HPV

• Nearly 20 million people in the United States are infected with HPV.
• 6.2 million Americans become infected each year with more than 50 percent of sexually active men and women infected with HPV at some time in their lives.
• Most HPV infections do not cause any symptoms and go away on their own.
• HPV can cause genital warts and warts in the oral and upper respiratory tract in both men and women.

There is no treatment for an HPV infection, but many of the conditions it causes can be treated.

Learn more about the latest HPV vaccine recommendations, and treatment for head and neck cancer at Penn.

Read More

Maintain Oral Health During Cancer Treatment

Elizabeta Evtimovska, DDS, MS, is a maxillofacial prosthodontist at Penn. In this article, she discusses complications from treatments for head and neck cancer, and how patients can prevent long-term side effects of head and neck cancer treatment.

Head and neck radiation and chemotherapy can cause a range of short and long-term oral complications.

The acute complications such as mucositis (sores) and infections, as well as others are managed by the oncology team during the treatment. Some of the long-term complication, such as xerostomia (dry mouth) and osteoradionecrosis (ORN), is a serious complication of radiation therapy for head and neck cancer that occurs in a small percentage of patients as result of head and neck radiation treatment.

Osteoradionecrosis is bone that has died. Because radiation works to destroy cancerous cells through the deprivation of oxygen and vital nutrients, it inevitably destroys normal cells as well, damaging small arteries and reducing circulation to the area of the mandible (jaw bone).

As there is no treatment for ORN, the focus is on prevention. This means, avoiding extractions of teeth from the radiated parts of the jaws and making sure that dentures fit properly and don’t cause any sores. It most often occurs in the setting of tooth extraction from the radiated parts of the jaws, but can also occur spontaneously. In both cases, there is exposed bone in the mouth which can be asymptomatic or it can be further complicated by infections, pain, and/or malodor.

Preparing for head and neck cancer therapy

Patients who are planning to undergo chemotherapy or radiation should be evaluated by a dentist prior to the start of treatment.

During this appointment, the patient’s oral condition is evaluated and it is determined if any teeth need to be extracted prior to the start of radiation treatment. This visit is also a perfect time to go over good oral health care.

In our practice, I advise patients to do the following during and after radiation:

• Maintain excellent oral hygiene by flossing and brushing every morning and evening and after every meal. If dry mouth develops, it is especially crucial to brush teeth after every meal and only drink water between meals, as opposed to sugary drinks or snacks.
• Use fluoride to prevent caries (when xerostomia, dry mouth, is present, the patient has increased risk of caries). Fluoride is especially important to prevent extracting teeth from the radiated parts of the jaws and therefore prevent osteoradionecrosis.
• Visit a local dentist regularly for regularly scheduled maintenance visits (cleanings), as well as any other routine dental treatment.

The severity of oral complications from chemoradiation differs depending on the diagnosis, the type of treatment administered, the amount and location of the delivered radiation, etc. Therefore, it is best to consult with a dentist prior to and after radiation in terms of the above discussed needs and recommended treatment.

Learn about managing cancer treatment side effects.

Learn about the Abramson Cancer Center Center’s Center for Head and Neck Cancer.

Read More

How to Eat Well With Head and Neck Cancer

After a head or neck cancer diagnosis, pain caused by the tumor or from surgical procedures or treatment can make chewing and swallowing difficult. 

Altering the consistency of your food and carefully selecting food items can make a big difference in your ability to eat and aid in making sure your body receives adequate calories, protein and other nutrients. 

It is important to maintain good nutrition during this period to aid recovery and healing as well as prevent complications that may impact treatment. 

Excessive weight loss during treatment and recovery may result in frequent hospitalizations and poor outcomes. For this reason, it’s important to choose foods that require little to no chewing and that don’t cause choking.  The food may not look as appealing as you are used to, but with the right seasonings, it still can be very flavorful.  In addition, sprinkling dried herbs such as parsley can enhance the eye appeal and taste.

Dietitians work closely with speech and swallowing therapists to determine patients’ nutritional needs and appropriate food and liquid consistencies. Those with head and neck cancer should seek support from a registered dietitian to make they are receiving the proper nutritional needs during treatment.

Learn more about nutrition programs at the Joan Karnell Cancer Center, or how to meet with a registered dietitian at the Joan Karnell Cancer Center at Pennsylvania Hospital.  Learn about nutrition services offered at the Abramson Cancer Center.

Watch videos to learn more about head and neck cancer treatment options offered at the Abramson Cancer Center.

Watch for upcoming recipes on this blog that are modified for smooth creamy textures.

Debra DeMille, MS, RD, CSO is a nutritional counselor at the Joan Karnell Cancer Center. Debra has worked at Pennsylvania Hospital since 1988 with the last 12 years specializing in oncology. Debra guides individuals receiving chemotherapy and radiation as well as addressing survivorship issues including the use of integrative therapies.


She conducts cooking programs and group counseling sessions for cancer survivors.

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Revolutionizing Head and Neck Surgery with TORS

Transoral robotic surgery (TORS) was invented and developed by the pioneering team of Bert W. O'Malley, Jr., MD and Gregory S. Weinstein, MD at Penn Medicine

TORS uses the state-of-the-art da Vinci® Surgical System, which allows surgeons better access to the areas of the throat for the removal of cancers and benign lesions via a minimally invasive robotic approach.

Surgeons benefit by having improved access to the tight confines of the throat and patients benefit in the short term with a faster and easier recovery and, in the long term, by outstanding cancer results and improved swallowing results compared to alternative treatments.

Benefits of TORS can include:

• Quicker return to normal activity
• Shorter hospitalization
• Reduced risk of long-term swallowing problems (most commonly seen with chemoradiation or traditional open surgery)
• Fewer complications compared to traditional open surgery
• Less scarring than traditional open surgery
• Less risk of infection
• Less risk of blood transfusion when compared to open surgery
• No routine use of tracheostomy during surgery

In this video, Drs. O'Malley and Weinstein explain the TORS procedure, and how Penn Medicine is revolutionizing care for patients with head and neck cancer.

TORS patient, Cynthia Miller along with other Penn patients discuss how the TORS procedure changed their lives.

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Patient Thanks Penn for Expert Thyroid Cancer Care

Kristina Black was only 23 when she was diagnosed with thyroid cancer. In this video, she talks about her diagnosis, and how her team of experts from Penn’s Abramson Cancer Center helped her through treatment so she could once again "sweat the small stuff" in life.

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Free Oral, Head and Neck Cancer Screening on April 27

The Joan Karnell Cancer Center at Pennsylvania Hospital is offering a free screening for oral, head and neck cancer from 11 am to 3 pm on Friday, April 27, 2012.

Oral, head and neck cancer refers to a variety of cancers that develop in the head and neck region, such as the oral cavity (mouth), the pharynx (throat), paranasal sinuses and nasal cavity, the larynx (voice box), thyroid and salivary glands, the skin of the face and neck, and the lymph nodes in the neck.

Common symptoms of oral, head and neck cancer

• Red or white patch in the mouth that lasts more than two weeks
• Change in voice or hoarseness that lasts more than two weeks
• Sore throat that does not subside
• Pain or swelling in the mouth or neck that does not subside
• Lump in the neck

Later symptoms of oral, head and neck cancer

• Ear pain
• Difficulty speaking or swallowing
• Difficulty breathing

The most effective prevention strategy continues to be the cessation of behaviors such as smoking, use of chewing tobacco and excessive alcohol consumption.  Eighty-five percent of head and neck cancers are related to tobacco use.  

Research has linked the increase of oral cancer incidence in young adults, a population traditionally at low risk, to the rise of human papillomavirus (HPV), a cancer-causing virus that can be transmitted through oral sex.

Date: Friday, April 27 2012
Time: 11 am to 3pm
Location: Pennsylvania Hospital, Otorhinolaryngology – Head and Neck Surgery (adjacent to the Spruce Building) 811 Spruce Street, Philadelphia, PA 19107

To register for this free event, call 800-789-PENN (7366).

For more information, call 215-829-6466

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Head and Neck Cancer Awareness Month

April is Head and Neck Cancer Awareness month.

Oral, head and neck cancer refers to a variety of cancers that develop in the head and neck region, such as the oral cavity (mouth), the pharynx (throat), paranasal sinuses and nasal cavity, the larynx (voice box), thyroid and salivary glands, the skin of the face and neck, and the lymph nodes in the neck.

Common warning signs are:

• Red or white patch in the mouth that lasts more than two weeks
• Change in voice or hoarseness that lasts more than two weeks
• Sore throat that does not subside
• Pain or swelling in the mouth or neck that does not subside
• Lump in the neck

Other warning signs that occur during later stages of the disease include:

• Ear pain
• Difficulty speaking or swallowing
• Difficulty breathing

As a part of the Focus On Cancer video series, Focus On Head and Neck Cancers addresses head and neck cancer diagnosis, treatment, research and survivorship.

In this video, New Jersey State Senator Diane Allen, together with other patients from the Abramson Cancer Center discuss their diagnoses, and their decisions to come to Penn Medicine for their cancer care.

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Personalized Radiation Therapy for Head and Neck Cancers

Alexander Lin, MD,  is a radiation oncologist at Penn Medicine who specializes in treating patients with head and neck cancer.

In this video, Dr. Lin discusses  personalized radiation therapy for cancer patients including intensity-modulated radiation therapy and proton therapy.  Dr. Lin also explains how the cancer team at Penn Medicine works together - under one roof - to create the best treatment plan for every patient.

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